VBS 2025 @ Prairieview Participant Form
This form is to register your children for the VBS program at Prairieview Covenant Church in New Richmond, WI on July 21-24, 2025.
If registering multiple children, please register each child individually!
Child's Name
*
Parent's Name(s)
*
Primary Phone Number
*
Secondary Phone Number (for emergencies)
*
Email
*
This address will receive a confirmation email
Grade During the 2024-2025 School Year
*
Please select one option.
3k
4k
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Select Option
3k
4k
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Any known allergies, medical conditions, or behavior information?
*
MEDICAL RELEASE - I, the parent/legal guardian of the child named above, a minor, do here authorize the leadership of Prairieview Covenant Church in New Richmond, WI as agents for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care or service, which is deemed advisable and is to be rendered to said minor, under the general or specific supervision of any physician and surgeon licensed, or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being rendered, and is given as specific consent to any all such diagnosis, treatment, or hospital care which the treating healthcare professional, in the exercise of their best judgment, may deem advisable to protect the life and health of said minor child.
*
Please select all that apply.
I agree to the medical release described above.
Submit
Description
This form is to register your children for the VBS program at Prairieview Covenant Church in New Richmond, WI on July 21-24, 2025.
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